What is the cause of persistently enlarged lymph nodes in a child?

From the Guidelines

If your child has enlarged chronic lymph nodes, you should consult a pediatrician for proper evaluation, as persistent enlargement can be a sign of an underlying infection or more serious condition. While most enlarged lymph nodes in children are benign and often due to recent infections, persistent enlargement (lasting more than 2-3 weeks) requires medical attention 1. The doctor will examine the nodes, noting their size, location, consistency, and whether they're painful. They'll likely ask about other symptoms like fever, weight loss, night sweats, or fatigue. No specific medication is recommended without proper diagnosis, as treatment depends on the underlying cause. Common causes include viral infections (like EBV or CMV), bacterial infections, or rarely, more serious conditions like lymphoma 1.

Some key points to consider when evaluating enlarged lymph nodes in children include:

• The size and location of the nodes, with normal lymph nodes in children being up to 1 cm in size, particularly in the neck, groin, and armpit areas 1
• The presence of other symptoms like fever, weight loss, or night sweats, which can indicate a more serious underlying condition 1
• The need for a thorough medical history and physical examination to determine the underlying cause of the enlarged lymph nodes 1
• The potential for imaging studies like ultrasound or biopsy if the nodes appear concerning or do not respond to initial treatment 1

It's essential to monitor for any changes in size, new symptoms, or signs of infection while waiting for the appointment, but avoid home remedies or over-the-counter medications without medical guidance. The pediatrician will provide guidance on the best course of action and recommend further testing or treatment if necessary.

From the Research

Causes of Enlarged Chronic Lymph Nodes in Children

• Lymphadenopathy can be caused by various factors, including infections, non-malignant conditions, and malignancies 2, 3, 4, 5
• In children, infectious causes of lymphadenopathy are more prevalent than neoplasms, but malignancies should not be overlooked 2, 3, 4

Diagnosis and Evaluation

• A thorough history and physical examination are crucial in developing a differential diagnosis for children with lymphadenopathy 2, 3, 4
• Laboratory studies, imaging, and judicious use of ultrasound can provide valuable information for accurate diagnosis 3, 4
• A systematic approach for diagnostics and appropriate management is necessary, with a focus on findings concerning for malignancy and the initial evaluation 3

Management and Treatment

• Surgical intervention is occasionally necessary for diagnosis and treatment of infections, and rarely indicated for the possibility of malignancy 2, 4
• The role and timing of surgical intervention should be carefully considered, with emphasis on minimizing pain and morbidity associated with surgical interventions in children 2
• A straightforward algorithm for evaluation and treatment of lymphadenopathy in children can help guide management decisions 2

Differential Diagnoses

• A broad differential diagnosis can be narrowed with a thorough clinical history, physical examination, laboratory studies, and imaging 3
• Common and uncommon infectious causes of cervical lymphadenopathy should be considered, as well as the possibility of neoplasms 4, 5